Bilateral interstitial keratitis in a patient with presumed brain tuberculoma / Ceratite intersticial bilateral em um paciente com tuberculoma cerebral presumido

ABSTRACT Interstitial keratitis is an inflammation of the corneal stroma without epithelium or endothelium involvement. The underlying causes are mostly infectious or immune mediated. Brazil has one of the highest incidence rates of tuberculosis in the world. Tuberculosis is considered one of the causes of interstitial keratitis. Malnutrition and anemia are risk factors of the disseminated disease. This is a case report of a 10-year-old child who presented with decreased visual acuity and a clinical diagnosis of bilateral interstitial keratitis and sclero-uveitis. The patient had been treated with topical steroids with partial improvement. Examinations revealed severe iron deficiency anemia, negative serologies for human immunodeficiency virus and syphilis, positivity for cytomegalovirus- and herpes simplex-specific IgG, and purified protein derivative of 17 mm. During the follow-up, the patient presented with tonic-clonic seizures, and magnetic resonance imaging findings suggested a central nervous system tuberculoma. Interstitial keratitis improvement was observed after specific tuberculosis treatment. This is the first case report describing the association of interstitial keratitis and central nervous system tuberculoma.

RESUMO A ceratite intersticial é uma inflamação do estroma corneano sem envolvimento epitelial ou endotelial causada principalmente por doenças infecciosas e imunomediadas. O Brasil tem altas taxas de tuberculose que deve ser lembrada como causa de ceratite intersticial. Desnutrição e anemia são fatores de risco da forma disseminada da tuberculose. Este é um relato de uma criança de 10 anos com redução de acuidade visual e diagnóstico clínico de ceratite intersticial bilateral e esclerouveíte. O paciente obteve melhora parcial da ceratite com corticoide tópico. Exames laboratoriais mostraram anemia ferropriva grave, sorologias negativas para HIV e sífilis; IgM negativo e IgG positivo para citomegalovírus e herpes simplex e PPD positivo (17 mm). Ele evoluiu com crises tônico-clônicas e a ressonância nuclear magnética revelou tuberculoma do sistema nervoso central. A melhora da ceratite intersticial foi observada após tratamento para tuberculose. Este é o primeiro caso que descreve a associação de ceratite intersticial e tuberculoma do sistema nervoso central.

Mapa de evidências sobre a efetividade clínica da medicina antroposófica: informe executivo / Evidence map on the clinical effectiveness of anthroposophic medicine: executive report

O mapa apresenta uma visão geral das evidências sobre os efeitos da Medicina Antroposófica, referida na PNPIC como Antroposofia Aplicada à Saúde, em função de sua natureza multiprofissional. A partir de uma ampla busca bibliográfica foram incluídos no mapa 33 estudos de revisão que analisaram o efeito de intervenções com medicamentos antroposóficos, terapias antroposóficas e terapias multimodais para desfechos clínicos. No mapa estão representadas 63 associações entre 5 tipos de intervenções e 19 desfechos clínicos, com indicação do efeito reportado e nível de confiança da evidência reportada nos estudos. Principais Achados: • As intervenções foram organizadas em três grupos: Medicamentos Antroposóficos (Viscum album ­ 22 revisões e Outros medicamentos ­ 4 revisões), Terapias Antroposóficas (Euritmia ­ 2 revisões e Outras terapias ­ 1 revisão) e Terapias Multimodais (Em Geral ­ 4 revisões). • As intervenções foram associadas a 19 desfechos ordenados em cinco grupos: Bem-estar e Qualidade de Vida, Câncer, Atenção à Saúde, Indicadores Fisiológicos e Metabólicos e Outras Condições Patológicas. • A maioria das associações foi para o grupo de desfecho Câncer, seguido pelo grupo Bem-estar e Qualidade de Vida. Dentre os desfechos, destaque para: Qualidade de Vida (12 revisões), Sobrevida (9 revisões), Segurança do Paciente (8 revisões) e Sintomas de Quimioterapia e Radioterapia (7 revisões). • Dentre as intervenções, a maioria das associações foi para Viscum album (48 associações). • As intervenções multimodais, outros medicamentos, Euritmia e outras terapias foram associadas aos desfechos: Resultado do tratamento (5 associações), Satisfação e Segurança do paciente (2 associações cada), Infecções respiratórias (3 associações), Coordenação cardiorrespiratória, Transtornos gastrointestinais e Edema (1 associação cada). Implicações para a prática e pesquisa: • Considerando os efeitos positivos reportados (em 27 associações), destaque para o uso de medicamento antroposófico Viscum album (19 associações) para os desfechos Qualidade de Vida, Segurança do Paciente e Sintomas de Quimioterapia e Radioterapia. • Quanto aos efeitos potencialmente positivos (em 21 associações), a maioria foi associado ao Viscum album (18 associações) para os desfechos: Sobrevida ao câncer, Sintomas de Quimioterapia e Radioterapia e Qualidade de Vida. • Identificaram-se efeitos inconclusivos em 15 associações para 11 diferentes desfechos, o que sugere uma necessidade de novos estudos primários sobre intervenções com medicamentos e terapias antroposóficas. • Não foram identificados estudos com ausência de efeito ou efeitos negativos.

Evidence map on the clinical effectiveness of anthroposophic medicine: executive report

The map provides an overview of the evidence on the effects of Anthroposophic Medicine, referred to in the National Policy on Integrative and Complementary Practices (PNPIC) as applied Anthroposophy in Health, due to its multiprofessional nature. Based on an extensive literature search, the map includes 33 review studies that analyzed the effects of interventions with anthroposophic medicines, anthroposophic therapies, and multimodal therapies on clinical outcomes. The map represents 63 associations between 5 types of interventions and 19 clinical outcomes, indicating the reported effect and level of confidence in the evidence reported in the studies. Key Findings: • The interventions were organized into three groups: Anthroposophic Medicines (Viscum album - 22 reviews and Other medicines - 4 reviews), Anthroposophic Therapies (Eurythmy - 2 reviews and Other therapies - 1 review), and Multimodal Therapies (Overall - 4 reviews). • The interventions were associated with 19 outcomes grouped into five categories: Well-being and Quality of Life, Cancer, Healthcare, Physiological and Metabolic Indicators, and other Pathological Conditions. • The majority of associations were found in the Cancer outcome group, followed by the Well-being and Quality of Life group. Notable outcomes included Quality of Life (12 reviews), Survival (9 reviews), Patient Safety (8 reviews), and Chemotherapy and Radiotherapy Symptoms (7 reviews). • Among the interventions, the majority of associations were related to Viscum album (48 associations). • Multimodal interventions, other medicines, eurythmy, and other therapies were associated with outcomes such as Treatment Outcome (5 associations), Patient Satisfaction and Safety (2 associations each), Respiratory Infections (3 associations), Cardiorespiratory Coordination, Gastrointestinal Disorders, and Edema (1 association each). Implications for Practice and Research: • Considering the reported positive effects (in 27 associations), the use of anthroposophic medicines Viscum album (19 associations) stands out for Quality of Life, Patient Safety, and Chemotherapy and Radiotherapy Symptoms outcomes. • Regarding potentially positive effects (in 21 associations), the majority were associated with Viscum album (18 associations) for Cancer Survival, Chemotherapy and Radiotherapy Symptoms, and Quality of Life outcomes. • Inconclusive effects were identified in 15 associations for 11 different outcomes, suggesting a need for further primary studies on interventions with anthroposophic medicines and therapies. • No studies were identified with no effect or negative effects.

Sexuality and fertility desire in a large cohort of individuals with 46, XY differences in sex development

Abstract Objective: To analyze aspects of sexual life and fertility desire among 46, XY DSD people, including those who changed their gender. Methods: It is a cross-sectional study including 127 adults (> 16 years of age) with 46, XY DSD (83 females; 44 males) from a Single Brazilian Tertiary-Care Medical Center. Results: Sexual fantasies and masturbation were more frequent in 46, XY DSD males, whereas orgasm and sexual life satisfaction were similar in both genders. More 46, XY DSD men than women had a long-term romantic relationship. 46, XY DSD women with prenatal androgen exposure reported more fear of being romantically rejected. External genitalia appearance at birth did not impact the sexuality of 46, XY DSD women after surgical genital treatment had been completed. Overall, the sexual life was similar between 46, XY men assigned as males and those who changed to the male gender. Regarding sexual orientation, most self-reported as heterosexual (91% and 92% of women and men, respectively). The desire for fertility had a similar prevalence in both genders, but more women than men considered infertility a barrier to a long-term romantic relationship. Twelve individuals (7 males) had children; 10 out of 12 have adopted children. Conclusion: Fertility desire was shared among 46, XY DSD people, regardless of gender. Prenatal androgen exposure reduced the desire for motherhood in 46, XY women. 46, XY DSD people who changed from female to male gender presented similar sexual parameters as those assigned as males. Among females, virilized genitalia at birth did not affect sexuality once the surgical treatment is completed.

A straightforward one-step strategy for SARS-CoV-2 diagnosis and screening of variants of concern: a multicentre study

BACKGROUND The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) has changed unevenly over time around the world. Although whole genome sequencing is the gold standard for virus characterisation, the discovery of alpha VOC causing spike gene target failure (SGTF) result, when tested using an reverse transcription real-time polymerase chain reaction (RT-qPCR) assay, has provided a simple tool for tracking the frequencies of variants. OBJECTIVES The aim of this study was to investigate if a multiplex RT-qPCR assay (BioM 4Plex VOC) could be used to detect SARS-CoV-2 and to perform a VOC screening test in a single reaction tube. Here, we present the multicentre study evaluating this assay. METHODS Twelve laboratories have participated in the multicentre study. The BioM 4Plex VOC was distributed to them with detailed instructions of how to perform the test. They were asked to test the BioM 4Plex VOC in parallel with their routine Commercial SARS-CoV-2 diagnostic assay. Additionally, they were requested to select SARS-CoV-2-positive samples with genome sequenced and lineage definition according to PANGO lineage classification. FINDINGS The BioM 4Plex VOC and commercial RT-PCR assay are equally effective in detecting SARS-CoV-2. Results revealed a specificity of 96.5-100% [95% confidence interval (CI)], a sensitivity of 99.8-100% (95% CI), and an accuracy of 99.8-100% (95% CI). A 99% concordance rate was found between results from the BioM 4Plex VOC and that from available genome sequencing data. MAIN CONCLUSIONS The BioM 4Plex VOC provides an effective solution to detect SARS-CoV-2 infections and screening for VOCs in a single reaction. It is a straightforward method to help us monitor the frequency and distribution of VOCs and develop strategies to better cope with the pandemics.

A straightforward one-step strategy for SARS-CoV-2 diagnosis and screening of variants of concern: a multicentre study

BACKGROUND The prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) has changed unevenly over time around the world. Although whole genome sequencing is the gold standard for virus characterisation, the discovery of alpha VOC causing spike gene target failure (SGTF) result, when tested using an reverse transcription real-time polymerase chain reaction (RT-qPCR) assay, has provided a simple tool for tracking the frequencies of variants. OBJECTIVES The aim of this study was to investigate if a multiplex RT-qPCR assay (BioM 4Plex VOC) could be used to detect SARS-CoV-2 and to perform a VOC screening test in a single reaction tube. Here, we present the multicentre study evaluating this assay. METHODS Twelve laboratories have participated in the multicentre study. The BioM 4Plex VOC was distributed to them with detailed instructions of how to perform the test. They were asked to test the BioM 4Plex VOC in parallel with their routine Commercial SARS-CoV-2 diagnostic assay. Additionally, they were requested to select SARS-CoV-2-positive samples with genome sequenced and lineage definition according to PANGO lineage classification. FINDINGS The BioM 4Plex VOC and commercial RT-PCR assay are equally effective in detecting SARS-CoV-2. Results revealed a specificity of 96.5-100% [95% confidence interval (CI)], a sensitivity of 99.8-100% (95% CI), and an accuracy of 99.8-100% (95% CI). A 99% concordance rate was found between results from the BioM 4Plex VOC and that from available genome sequencing data. MAIN CONCLUSIONS The BioM 4Plex VOC provides an effective solution to detect SARS-CoV-2 infections and screening for VOCs in a single reaction. It is a straightforward method to help us monitor the frequency and distribution of VOCs and develop strategies to better cope with the pandemics.

Updating recommendations of the Brazilian Group of Flow Cytometry (GBCFLUX) for diagnosis of acute leukemias using four-color flow cytometry panels

ABSTRACT Introduction: Flow cytometry has become an increasingly important tool in the clinical laboratory for the diagnosis and monitoring of many hematopoietic neoplasms. This method is ideal for immunophenotypic identification of cellular subpopulations in complex samples, such as bone marrow and peripheral blood. In general, 4-color panels appear to be adequate, depending on the assay. In acute leukemias (ALs), it is necessary identify and characterize the population of abnormal cells in order to recognize the compromised lineage and classify leukemia according to the WHO criteria. Although the use of eightto ten-color immunophenotyping panels is wellestablished, many laboratories do not have access to this technology. Objective and Method: In 2015, the Brazilian Group of Flow Cytometry (Grupo Brasileiro de Citometria de Fluxo, GBCFLUX) proposed antibody panels designed to allow the precise diagnosis and characterization of AL within available resources. As many Brazilian flow cytometry laboratories use four-color immunophenotyping, the GBCFLUX has updated that document, according to current leukemia knowledge and after a forum of discussion and validation of antibody panels. Results: Recommendations for morphological analysis of bone marrow smears and performing screening panel for lineage (s) identification of AL were maintained from the previous publication. The lineage-oriented proposed panels for B and T cell acute lymphoblastic leukemia (ALL) and for acute myeloid leukemia (AML) were constructed for an appropriate leukemia classification. Conclusion: Three levels of recommendations (i.e., mandatory, recommended, and optional) were established to enable an accurate diagnosis with some flexibility, considering local laboratory resources and patient-specific needs.

Minimal residual disease assessment in acute lymphoblastic leukemia by 4-color flow cytometry: Recommendations from the MRD Working Group of the Brazilian Society of Bone Marrow Transplantation

Abstract Introduction: The minimal residual disease (MRD) status plays a crucial role in the treatment of acute lymphoblastic leukemia (ALL) and is currently used in most therapeutic protocols to guide the appropriate therapeutic decision. Therefore, it is imperative that laboratories offer accurate and reliable results through well standardized technical processes by establishing rigorous operating procedures. Method: Our goal is to propose a monoclonal antibody (MoAb) panel for MRD detection in ALL and provide recommendations intended for flow cytometry laboratories that work on 4-color flow cytometry platforms. Results and conclusion: The document includes pre-analytical and analytical procedures, quality control assurance, technical procedures, as well as the information that needs to be included in the reports for clinicians.

Analytical and clinical performance of molecular assay used by the Brazilian public laboratory network to detect and discriminate Zika, Dengue and Chikungunya viruses in blood

ABSTRACT In response to the Zika epidemics in Brazil, the ZDC molecular assay (Bio-Manguinhos) was developed and registered at the Brazilian Regulatory Agency of Health Surveillance - ANVISA. The circulation of Zika (ZIKV) Dengue (DENV) and Chikungunya (CHIKV) viruses and their clinical similarities are challenges to correctly diagnose these viruses. The simultaneous detection of ZIKV, DENV and CHIKV is an important tool for diagnosis and surveillance. Here, we present the analytical and clinical performance evaluation of ZDC molecular assay (Bio-Manguinhos) at the public health laboratories three years after its registration at ANVISA. The clinical performance demonstrates the ZDC molecular assay (Bio-Manguinhos) has 100% sensitivity and 100% specificity to detect and discriminate ZIKV, CHIKV, and DENV from clinical plasma samples. The ZDC molecular assay (Bio-Manguinhos) results were highly reproducible and no cross-reactivity was seen during testing with a panel of other infectious agents. In conclusion, the ZDC molecular assay (Bio-Manguinhos) is an accurate and reliable tool to monitor Zika, dengue and chikungunya infections in countries like Brazil with simultaneous circulation of the three viruses.

Epidemiological profile and visual outcome of ocular trauma in a referral center in northeastern Brazil / Perfil epidemiológico e prognóstico visual do trauma ocular em um centro de referência da região nordeste do Brasil

Abstract Objectives: To evaluate the epidemiological profile and prognosis of patients with mechanical ocular trauma. Methods: Descriptive cross-sectional observational study of consecutive patients evaluated during a one-year period at a public referral center in São Luis, Maranhão, Brazil. The Ocular Trauma Score (OTS) was used to estimate final visual acuity. The variables were analyzed using the chi-square test with a significance level of 5%. Results: Out of a total of 154 patients (mean age of 30.1 years), 27.92% were younger than 16 years, and 81.8% were men, with most coming from the state's countryside (55.2%). Most of the patients were dependents (34%) or rural workers (19%). Regarding the OTS prognosis, 33.77% of the patients were category 5 and 31.16% category 1 or 2, indicating worse prognosis. The best prognoses (visual outcomes) were inversely proportional to age and time to treatment (p<0.001). Conclusion: Ocular trauma remains an important cause of ocular morbidity in childhood and in informal work. Adult supervision and socio-educational measures are mandatory to change this scenario.

Resumo Objetivos: Avaliar o perfil epidemiológico e o prognóstico visual de pacientes com trauma ocular mecânico. Métodos: Estudo observacional transversal descritivo de pacientes consecutivos atendidos durante o período de um ano em um centro de referência público em São Luís, Maranhão. O Ocular Trauma Score foi aplicado a fim de estimar a acuidade visual final. As variáveis foram analisadas por meio do teste de Qui-quadrado com nível de significância de 5%. Resultados: Encontrou-se 154 pacientes tratados, a média de idade foi 30,1 anos, 27,92% menores que 16 anos, homens (81,8%) e do interior do Estado (55,2%). A maioria eram dependentes (34%), dos trabalhadores ocorreu o predomínio do trabalhador rural (19%). Quanto ao prognóstico, 33,77% dos pacientes apresentavam-se na categoria 5 e 31,16% na 1 ou 2, de pior prognóstico. Os melhores prognósticos foram inversamente proporcionais a idade e ao tempo até o atendimento (p<0,001). Conclusão: O trauma ocular se mantém como importante causa de morbidade ocular na infância e no trabalho informal. A supervisão de adultos e medidas socioeducativas são fundamentais para mudar esse cenário.

One-step real-time PCR assay for detection and quantification of RNA HCV to monitor patients under treatment in Brazil

ABSTRACT The Brazilian Public Health Service provides freely αPEG-IFN to treat patients infected with HCV. The primary goal of HCV therapy is the long-term elimination of HCV from the blood to reduce the risk of HCV associated complications and death. Patient viremia affects the treatment duration and response, thus influencing clinical decisions. We developed a high-throughput method to perform the quantification of RNA hepatitis C virus (HCV) virus load in plasma samples to monitor patients under treatment. The method is based on a duplex detection, in a one-step real-time RT-PCR assay and it has been validated according to the rules established by the official Brazilian regulatory agency (ANVISA). This new method was compared to a commercial kit (Cobas/Taqman HCV Test v2.0 - Roche), showing virus load results with significant correlation between them (p= 0,012) using commercial and clinical panels. In addition, 611 samples from patients treated with peguilated alfa-interferon (αPEG-IFN) from different regions of Brazil were analyzed. Our one-step real-time RT-PCR assay demonstrated good performance in viral load measurement and in treatment course monitoring, with acceptable sensitivity and specificity values.

Androgen insensitivity syndrome: a review

ABSTRACT Androgenic insensitivity syndrome is the most common cause of disorders of sexual differentiation in 46,XY individuals. It results from alterations in the androgen receptor gene, leading to a frame of hormonal resistance, which may present clinically under 3 phenotypes: complete (CAIS), partial (PAIS) or mild (MAIS). The androgen receptor gene has 8 exons and 3 domains, and allelic variants in this gene occur in all domains and exons, regardless of phenotype, providing a poor genotype - phenotype correlation in this syndrome. Typically, laboratory diagnosis is made through elevated levels of LH and testosterone, with little or no virilization. Treatment depends on the phenotype and social sex of the individual. Open issues in the management of androgen insensitivity syndromes includes decisions on sex assignment, timing of gonadectomy, fertility, physcological outcomes and genetic counseling.

Insect galls in Rupestrian field and Cerrado stricto sensu vegetation in Caetité, Bahia, Brazil / Galhas de insetos em vegetação de Campo Rupestre e de Cerrado stricto sensu de Caetité, Bahia, Brasil

Abstract: We investigated insect galls in Rupestrian field and Cerrado vegetation in the municipality of Caetité (BA), Brazil, between August/2015 and June/2016. This is the first study of gall diversity in Rupestrian field vegetation in that state. We encountered 48 different morphotypes of galls, distributed among 17 different plant species belonging to 13 genera and 21 host plant families. The greatest gall richness was observed in Cerrado (n=39) as compared to Rupestrian field (n=9) vegetation. The principal botanical families observed with galls were Leguminosae, Malpighiaceae, and Myrtaceae, with 10, 8 and 4 morphotypes, respectively. The genera showing the greatest gall diversity were Copaifera L. (n=6) (Leguminosae-Detarioideae), Croton L. (n=2) (Euphorbiaceae), Mimosa L. (n=2) (Leguminosae-Caesalpinioideae), Byrsonima Rich. ex Kunth (n=2) (Malpighiaceae), and Eugenia L. (n=2) (Myrtaceae). The super-host species was Copaifera sabulicola J.A.S. Costa & L.P. Queiroz (n= 5). Most galls occurred on leaves, being globoid, glabrous, isolated, and unilocular. Most gall-inducing insect species belong to the Cecidomyiidae family, while the associated fauna was represented by Hymenoptera and Lepidoptera. We recorded here for the first time galls on Ocotea velutina (Mart. ex Ness) Rohwer (Lauraceae) and Miconia alborufescens Naudin (Melastomataceae). The results indicate the need for more studies to understand the dynamics of the insect-induced galls in Rupestrian field.

Resumo: Este estudo investigou e caracterizou as galhas de uma área de Campo rupestre e de Cerrado no município de Caetité (BA) no período de agosto de 2015 a junho de 2016. Esta é a primeira contribuição para o conhecimento da diversidade de galhas de Campo rupestre neste estado. Foram registrados 48 morfotipos de galhas distribuídas em 17 espécies distintas, pertencentes a 13 gêneros e 21 famílias de plantas hospedeiras. A maior riqueza de galhas foi observada no Cerrado (n=39), quando comparada com o Campo rupestre (n=9). As famílias botânicas mais ricas em galhas foram Leguminosae, Malpighiaceae e Myrtaceae, com 10, 8 e 4 morfotipos, respectivamente. Os gêneros com maior diversidade de galhas foram Copaifera L. (n=6) (Leguminosae-Detarioideae), Croton L. (n=2) (Euphorbiaceae), Mimosa L. (n=2) (Leguminosae-Caesalpinioideae), Byrsonima Rich. ex Kunth (n=2) (Malpighiaceae) e Eugenia L. (n=2) (Myrtaceae). A espécie super-hospedeira foi Copaifera sabulicola J.A.S. Costa & L.P. Queiroz (n= 5). A maioria das galhas ocorreu nas folhas, sendo globoides, glabras, isoladas e uniloculares. A maioria dos indutores pertence à família Cecidomyiidae, enquanto que a fauna associada está representada por Hymenoptera e Lepidoptera. Foram registradas pela primeira vez galhas em Ocotea velutina (Mart. ex Ness) Rohwer (Lauraceae) e Miconia alborufescens Naudin (Melastomataceae). Os resultados encontrados indicam a necessidade de mais estudos para entender a dinâmica dos insetos indutores de galhas em Campos rupestres.

Low estrogen doses normalize testosterone and estradiol levels to the female range in transgender women

OBJECTIVE: The ideal dosage of cross-sex hormones remains unknown. The aim of this study was to evaluate the luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin levels after low-dose estrogen therapy with or without cyproterone acetate in transgender women. METHODS: The serum hormone and biochemical profiles of 51 transgender women were evaluated before gonadectomy. Hormone therapy consisted of conjugated equine estrogen alone or combined with cyproterone acetate. The daily dose of conjugated equine estrogen was 0.625 mg in 41 subjects and 1.25 mg in 10 subjects, and the daily dose of cyproterone acetate was 50 mg in 42 subjects and 100 mg in one subject. RESULTS: Estrogen-only therapy reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 731.5 to 18 ng/dL, 6.3 to 1.1 U/L and 9.6 to 1.5 U/L, respectively. Estrogen plus cyproterone acetate reduced the testosterone, luteinizing hormone and follicle-stimulating hormone levels from 750 to 21 ng/dL, 6.8 to 0.6 U/L and 10 to 1.0 U/L, respectively. The serum levels of luteinizing hormone, follicle-stimulating hormone, testosterone, estradiol and prolactin in the patients treated with estrogen alone and estrogen plus cyproterone acetate were not significantly different. The group receiving estrogen plus cyproterone acetate had significantly higher levels of gamma-glutamyltransferase than the group receiving estrogen alone. No significant differences in the other biochemical parameters were evident between the patients receiving estrogen alone and estrogen plus cyproterone acetate. CONCLUSION: In our sample of transgender women, lower estrogen doses than those usually prescribed for these subjects were able to adjust the testosterone and estradiol levels to the physiological female range, thus avoiding high estrogen doses and their multiple associated side effects.

Tripartite symbiosis of Sophora tomentosa, rhizobia and arbuscular mycorhizal fungi

ABSTRACT Sophora tomentosa is a pantropical legume species with potential for recovery of areas degraded by salinization, and for stabilization of sand dunes. However, few studies on this species have been carried out, and none regarding its symbiotic relationship with beneficial soil microorganisms. Therefore, this study aimed to evaluate the diversity of nitrogen-fixing bacteria isolated from nodules of Sophora tomentosa, and to analyze the occurrence of colonization of arbuscular mycorrhizal fungi on the roots of this legume in seafront soil. Thus, seeds, root nodules, and soil from the rhizosphere of Sophora tomentosa were collected. From the soil samples, trap cultures with this species were established to extract spores and to evaluate arbuscular mycorhizal fungi colonization in legume roots, as well as to capture rhizobia. Rhizobia strains were isolated from nodules collected in the field or from the trap cultures. Representative isolates of the groups obtained in the similarity dendrogram, based on phenotypic characteristics, had their 16S rRNA genes sequenced. The legume species showed nodules with indeterminate growth, and reddish color, distributed throughout the root. Fifty-one strains of these nodules were isolated, of which 21 were classified in the genus Bacillus, Brevibacillus, Paenibacillus, Rhizobium and especially Sinorhizobium. Strains closely related to Sinorhizobium adhaerens were the predominant bacteria in nodules. The other genera found, with the exception of Rhizobium, are probably endophytic bacteria in the nodules. Arbuscular mycorrhizal fungi was observed colonizing the roots, but arbuscular mycorhizal fungi spores were not found in the trap cultures. Therefore Sophora tomentosa is associated with both arbuscular mycorhizal fungi and nodulating nitrogen-fixing bacteria.

Chest drainage teaching and training for medical students. Use of a surgical ex vivo pig model

ABSTRACT PURPOSE: Implement a constructivist approach in thoracic drainage training in surgical ex vivo pig models, to compare the acquisition of homogeneous surgical skills between medical students. METHODS: Experimental study, prospective, transversal, analytical, controlled, three steps. Selection, training, evaluation. Inclusion criteria: a) students without training in thoracic drainage; b) without exposure to constructivist methodology. 2) Exclusion criteria: a) students developed surgical skills; b) a history of allergy. (N = 312). Two groups participated in the study: A and B. Lecture equal for both groups. Differentiated teaching: group A, descriptive and informative method; group B, learning method based on problems. A surgical ex vivo pig model for training the chest drain was created. Were applied pre and post-test, test goal-discursive and OSATS scale. RESULTS: Theoretical averages: Group A = 9.5 ± 0.5; Group B = 8.8 ± 1.1 (p = 0.006). Medium Practices: Group A = 22.8 ± 1.8; Group B = 23.0 ± 2.8 (p <0.001). CONCLUSION: Through the constructivist methodology implemented in the thoracic drainage training in surgical ex vivo pig models, has proven the acquisition of surgical skills homogeneous compared among medical students.

Insect galls from Serra Geral, Caetité, BA, Brazil / Galhas de insetos da Serra Geral, Caetité, Bahia, Brasil

We inventoried and characterized the kinds of gall, gall-inducing insects and host plants from Serra Geral between August 2013 and July 2014. Two phytophysiognomies, cerrado sensu stricto and caatinga-cerrado, were examined monthly along transects during ca. 4 hours per visit, totaling 48 hours of sampling effort. A total of 49 gall morphotypes were found on 14 species of host plants in 18 genera and 13 families. Fabaceae and Malpighiaceae were the families with the most galls, with 22 and 10 gall morphotypes, respectively. The genera of host plant with the greatest richness of galls were Copaifera L. (n=10), Bauhinia Benth. (n=6), and Mimosa L. (n=5). Galls were found on leaves, buds and stems. The majority of the galls were globoid, glabrous, isolated, and one-chambered. The inducers belong to Coleoptera, Diptera, and Lepidoptera, Cecidomyiidae (Diptera) being the most frequent and diverse gall-inducers. The associated fauna included parasitoids (Hymenoptera), successors (Formicidae), and predators (Pseudoscorpiones), obtained from 13, 2, and 1 gall morphotypes, respectively. Five plant taxa are recorded as hosts of gall-inducing insects for the first time.

Inventariamos e caracterizamos os tipos de galhas, insetos galhadores e plantas hospedeiras da Serra Geral entre agosto de 2013 a julho de 2014. Duas fitofisionomias, cerrado sensu stricto e de transição caatinga-cerrado, foram examinadas ao longo de trilhas è procura de galhas entomógenas, durante quatro horas por visita, totalizando 48 horas de esforço amostral. Um total de 49 morfotipos de galhas foi encontrado em 14 espécies vegetais pertencentes a 18 gêneros e 13 famílias. Fabaceae e Malpighiaceae foram as famílias botânicas com maior riqueza de galhas, com 22 e 10 morfotipos, respectivamente. Os gêneros de planta hospedeira mais ricos em galhas foram Copaifera L. (n=10), Bauhinia Benth. (n=6) e Mimosa L. (n=4). As galhas foram encontradas em folhas, gemas e caules. A maioria das galhas foram globoides, glabras, isoladas e uniloculares. Os galhadores pertencem ès ordens Coleoptera, Diptera e Lepidoptera, sendo os insetos da família Cecidomyiidae (Diptera) os indutores mais frequentes e diversificados. A fauna associada incluiu parasitoides (Hymenoptera), sucessores (Formicidae, Hymenoptera) e predadores (Pseudoscorpiones), obtidos de 13, dois e um morfotipos de galhas, respectivamente. Cinco táxons de plantas são registrados como hospedeiras de galhas pela primeira vez.

Componentes da teoria social de aprendizagem numa ferramenta para ensino na Enfermagem / Componentes de la teoría de aprendizaje social en una herramienta para la enseñanza en Enfermería / Components of social learning theory in a tool for teaching Nursing

RESUMOObjetivo:identificar componentes fundamentais da teoria social de aprendizagem numa ferramenta computacional para auxílio ao ensino do processo de raciocínio para elaboração do diagnóstico de enfermagem.Método:estudo qualitativo que analisou o discurso, coletado por meio de grupo focal, de 18 professores e estudantes de duas escolas de enfermagem brasileiras.Resultados:os temas foram agrupados em quatro categorias relacionadas aos componentes da teoria e em 13 subcategorias.Conclusão: o significado da aprendizagem pode ser ampliado pela didática do professor e evidenciado pela relação entre a sistematização e o raciocínio; para aprender fazendo são necessários pré-requisitos e um processo de motivação e capacitação, que também é inerente à aprendizagem pela formação de identidade no grupo; no sentimento de pertencimento a um determinado grupo tornaram-se visíveis aspectos relacionados à profissão em detrimento do pertencimento a uma comunidade de prática de aprendizagem.

RESUMENObjetivo:identificar composición fundamental de la teoría social de aprendizaje en una herramienta computacional para el auxilio a la ensenanza del proceso de raciocinio para elaboración del diagnóstico de enfermería.Método:fue realizado un estudio calificativo, lo cual analizó el discurso, colectado por medio del grupo foco, con 18 maestros y estudiantes de dos escuelas de enfermería brasilenas.Resultados:los temas fueron agrupados en cuatro categorías relacionadas a los componentes de la teoría y en 13 subcategorías.Conclusión:el significado de la aprendizaje puede ser ampliado por la didáctica del maestro y por la relación en medio de sistematización y el raciocinio; para aprendizaje haciendo son necesarios requisitos previos y uno proceso de motivación y capacitación, además, también es inherente el aprendizaje por la formación de identidad en el grupo; con sentido de pertenencia a un determinado grupo se hicieron visibles aspectos relacionados a la profesión en detrimento de suya pertenencia a una comunidad de práctica del aprendizaje.

ABSTRACTObjective:to identify key components of the social learning theory in a computational tool to aid in teaching the reasoning process for the preparation of a nursing diagnosis.Method:qualitative study that analyzed the statements collected through a focus group of 18 teachers and students from two Brazilian nursing schools.Results:the themes were grouped into four categories related to the components of the theory and into 13 subcategories.Conclusion:the meaning of learning can be extended by the teacher's didactics and corroborated by the relationship between systematization and reasoning. To learn by doing, some prerequisites are required as is a process of motivation and qualification, which are also inherent to learning by forming an identity in the group. In the feeling of belonging to a particular group, aspects related to the profession become visible as opposed to the aspects of belonging to a community of practice of learning.